A migraine headache is among the most disabling inflictions globally, in part, because it adversely affects quality-of-life. Some pharmaceuticals are used prophylactically to decrease migraine frequency and severity, but they have unwanted side effects. In traditional Iranian medicine, coriander (Coriandrum sativum, Apiaceae) fruit, rose (Rosa damascena, Rosaceae) flower, and violet (Viola odorata, Violaceae) flower are used to treat headache. According to the authors, there are no published studies evaluating the combination of coriander, rose, and violet (CRV) as a treatment of pain or migraine. Hence, the purpose of this randomized, double-blind, placebo-controlled study was to evaluate the effect of CRV on the frequency, duration, and severity of migraine.
Patients (n = 88, aged 15-45 years) with a diagnosis of migraine headache (with or without aura) according to the International Headache Society (IHS) criteria and who visited Besat Neurology Clinic No.4 at Kerman University of Medical Sciences; Kerman, Iran, from September 2016 to March 2017 were recruited for the study. Included patients had ≥ 4 migraines in the past three months. Excluded patients were pregnant or planning to become pregnant, lactating, were receiving treatment for a serious medical condition, or were not compliant with the study protocol.
Coriander fruit, rose flowers, and violet flowers were purchased from the “Iran herbal medicine market.” Botanical identity was authenticated by a pharmacognosist in the Pharmacy Department of Kerman University of Medical Sciences, and voucher specimens were retained. Qualitative and microbial controls were performed at Barij Essence Company (Kashan, Iran). The samples were powdered, blended 1:1:1, and filled into 500 mg capsules.
Patients took 500 mg capsules containing either CRV or placebo (starch) 3x/day (1.5 mg/day) for four weeks. All patients also received 20 mg propranolol 2x/day (40 mg/day). At baseline, patients were asked to state the average frequency and duration of headache over the past three months, and the rate average severity of headache on a visual analog scale (VAS). Patients recorded the frequency, duration, and severity of headaches during the study period on printed forms. At the end of the second and fourth weeks, patients were seen by the neurologist, who reviewed the forms and recorded any adverse effects (AEs).
One patient from each group was discontinued (one for a positive pregnancy test and one for inappropriate use of prescription drugs); thus, 43 patients in each group completed the study per protocol. Baseline characteristics were similar between groups.
Compared with placebo, the CRV group had a significant decline in the duration, frequency, and severity of migraine at two weeks (p = 0.007, P < 0.001, and P < 0.001, respectively) and four weeks (P < 0.001 for all). The raw data were not reported; the mean frequency, duration, and severity of migraine data at baseline, two weeks, and four weeks were presented in graphs (outcome versus time). Extrapolating from the graph of the mean frequency of migraine/week, it appears that the mean frequency of migraine at baseline was ˃12 migraines/month. However, given the inclusion criterion of ≥ 4 migraines in the past three months (i.e., an average of 1.33 migraines/month, it is probable that some participants did not have a migraine or had fewer migraines during the four-week study simply due to chance. AEs were not reported.
The authors conclude that the combination of violet, rose, and coriander reduces the duration, frequency, and severity of migraine. Acknowledged limitations of the study include the short duration, which “makes it impossible to claim anything about its
efficacy in long-term use,” and the lack of follow-up post-intervention. The authors recommend longer duration studies with larger sample size and longer follow-up to confirm the findings of this pilot study and compare the efficacy of the herbal combination with pharmaceutical prophylactic treatments for migraine. Given the limitations of this study, the results should be viewed as a preliminary. The authors received no financial support and have no conflict of interest.
Kamali M, Seifadini R, Kamali H, Mehrabani M, Jahani Y, Tajadini H. Efficacy of combination of Viola odorata, Rosa damascena and Coriandrum sativum in prevention of migraine attacks: a randomized, double blind, placebo- controlled clinical trial. Electron Physician. 2018;10(3):6430-6438. doi: 10.19082/6430.